COVID-19 increases the risk of adverse birth outcomes, especially among women living with HIV
According to a study conducted in Botswana, women living with HIV who tested positive for COVID-19 at the time of delivery were significantly more likely to experience adverse birth outcomes than other women living with HIV.
The study, presented Monday at the Conference on Retroviruses and Opportunistic Infections (CROI 2022), also found that women who tested positive for COVID-19 at the time of delivery were more likely to experience adverse birth outcomes. , such as pre-eclampsia, preterm labor and stillbirth, regardless of HIV status.
Both COVID-19 and HIV have been associated with an increased risk of adverse birth outcomes, but there is little information on their combined impact in settings with high HIV prevalence among women of reproductive age. . A systematic review of 42 studies, published in April 2021 before the Delta variant wave, found that SARS-CoV-2 infection during pregnancy was associated with increased risks of pre-eclampsia, stillbirth and preterm birth in studies conducted extensively in Europe, China and North America.
But these studies did not provide information on whether HIV increases the risk of adverse birth outcomes in women with SARS-CoV-2. This issue is particularly relevant for women living with HIV in sub-Saharan Africa, where HIV prevalence is high and access to SARS-CoV-2 vaccination remains limited.
Maya Jackson-Gibson of Northwestern University and her colleagues conducted a study to determine whether COVID-19 increases the risk of adverse birth outcomes in women living with HIV.
The study used the birth outcome surveillance system already in place to capture the effects of HIV and antiretroviral treatment outcomes in Botswana, the Tsepamo Study. Data on COVID-19 status at the time of delivery began to be collected from participating hospitals in 2020-2021.
This analysis examined birth outcomes at 13 Tsepamo sites from September 2020 to November 15, 2021, which was before the spread of the Omicron variant in Botswana.
Women were included in the study if they had a known HIV status, had given birth to a single child, and had been tested for COVID-19 between 14 days before delivery and up to three days after delivery.
During the study period, 11,483 women were tested for COVID-19, 4.7% tested positive (539) and of these, 144 were living with HIV (44% of women giving birth at the study sites had not been tested for COVID-19 and symptomatic women may have been more likely to be screened due to a limited supply of test kits). Women living with HIV were significantly more likely to test positive for COVID-19 at delivery (5.6% vs 4.3%, p
COVID-19 cases peaked in July 2021, when the wave of the Delta variant led to one in ten pregnant women testing positive for COVID-19 during childbirth. Four percent of women who tested positive died during the study period, and the incidence of death was higher after the emergence of the Delta variant (5%) from April 2021 than during the period. previous (2%).
Adverse birth outcomes occurred more frequently in women who tested positive for COVID-19 (31%) than in those who did not (26%). After adjusting for age, the overall rate was 31% higher in women who tested positive. The preterm birth rate was 60% higher, the very preterm birth rate 40% higher, and the stillbirth rate 90% higher among those who tested positive. Neonatal, small-for-gestational-age, and very-short-for-gestational-age mortality rates did not differ significantly by COVID-19 status.
The approximate doubling of the risk of stillbirth in women with COVID-19 is similar to the increased risk of stillbirth associated with COVID-19 seen in a study of 1.2 million women who gave birth in the United States between March 2020 and September 2021. US Centers for Disease Control investigators estimated that approximately 30% of the women assessed in this study had been vaccinated. The increased risk of stillbirth may be a consequence of disruption of blood flow and inflammation of the placenta due to SARS-CoV-2 infection, suggesting that preventing severe COVID-19 illness could also reduce the risk of stillbirth.
Adverse birth outcomes were significantly higher in HIV-positive women who tested positive for COVID-19 (43%) than in HIV-positive women without COVID-19 (30%). After adjusting for age, women living with HIV and COVID-19 had a 78% higher risk of adverse birth outcome, a 65% higher risk of severe birth outcome, two times greater risk of preterm or very preterm birth and a 65% higher risk of having a small-for-gestational-age child. COVID-19 status did not affect the risk of stillbirth or neonatal death.
Very few of the women who participated in this study had been vaccinated against COVID-19. Vaccination began in Botswana at the end of 2021 and prioritized people over 65. Population-level data on the impact of vaccination on adverse birth outcomes are limited; studies published to date have addressed concerns about the potential excess risk of adverse birth outcomes associated with vaccination (finding none) rather than exploring the equally pressing question of how the lack of access to the vaccine contributes to an excess risk of adverse birth outcomes, particularly among women with HIV.
Jackson-Gibson M et al. The impact of COVID-19 on adverse birth outcomes in Botswana by HIV status. Conference on retroviruses and opportunistic infections, abstract 29, 2022.
See the abstract on the conference website.